No abstract

Background: Composite reconstruction with a dermal substitute followed by skin graft is sometimes used for reconstructing high-quality skin while preserving donor sites. This often necessitates 2 separate procedures, additional general anesthetic, and longer hospitalization. Concurrent use of dermal substitutes and skin graft in a single stage has been previously reported in small series. Here, we report our experience with single-stage skin reconstruction with Integra and split-thickness skin graft for coverage of wounds post burn eschar excision and post burn scar contracture release. Methods: This is a retrospective review of consecutive operations from 2013 to 2017 in which single-stage bilayer reconstruction (SSBR) was performed. Data were obtained from electronic medical records and perioperative photographs. Results: In this 5-year period, 13 surgical sites were identified in which SSBR was used in 8 subjects. Average and median graft take was 86.2% and 95%, respectively. Graft take was over 90% in 10 out of 13 cases. One case required regrafting after initial graft failure. Conclusions: In the appropriate setting, SSBR is a practical technique in covering wounds post burn eschar excision and post burn scar contracture release resulting in reasonable graft take. Use of noncontaminated wound beds is crucial. Although there is risk of regrafting, it is not clear whether this risk is any higher than in split-thickness skin grafting alone. This study was unable to evaluate contribution of dermal substitute to contraction, function, and mobility, nor how hypothesized improvement of skin quality compares to the original thick dermal substitute. We recommend further investigation.

Background:The purpose of this study is to assess which personal characteristics and external factors are important contributors to eventual success.Methods:The authors distributed a survey to all members of the American Association of Plastic Surgeons and asked responders to rate the importance of 10 preselected qualities in contributing to their personal success. Survey outcomes were analyzed across different demographic groups.Results:Of the 580 American Association of Plastic Surgeons members who were surveyed, 295 returned completed surveys. Overall analysis indicates that hard work, compassion, and manual dexterity are the 3 most important attributes. Many significant differences are observed across demographic groups, indicating potential biases among the survey responders. Notably, we find that male surgeons attribute mentorship to success much more so than female surgeons (Column Trend Exact [CTE], P = 0.021), whereas female surgeons are more likely to attribute their success to hard work (CTE, P = 0.023). Similarly, those who have been program directors credit their success to mentoring more so than nonprogram directors (CTE, P < 0.00001). The authors also found that senior surgeons, as measured by years in practice, place greater emphasis on mentoring and career opportunities than younger surgeons (Mantel-Haenszel Trend, P = 0.003 and 0.0009, respectively). It is also interesting to note that individual talent qualities tend to be favored by more senior surgeons and those with more distant ties to academia.Conclusion:The authors believe that recognizing the relative importance of such factors, and their associated biases, is essential for the process of selecting and developing future successful plastic surgeons.

Summary:We report 3 cases of breast pyoderma gangrenosum in patients undergoing total mastectomy with immediate reconstruction. All three received systemic corticosteroid treatment, resulting in resolution of symptoms. As experience grew, early diagnosis in the third patient helped prosthesis salvage and timely return to the original course of reconstruction. This represents the first report of prosthesis salvage from post breast reconstruction pyoderma gangrenosum, and it demonstrates that implant removal is not always necessary during management of this rare condition.